Quality Business Analyst

The Quality Business Analyst works collaboratively with various business areas to ensure compliance with established metrics and adherence to company policies and procedures. Through auditing, the analyst identifies areas for improvement, system inconsistencies, and training opportunities to enhance operational excellence, ultimately supporting the delivery of high-quality service to our clients and members.

Key Responsibilities:

* Review operational activities end-to-end to ensure accuracy and completeness.

* Provide timely documented feedback on issues identified at the processor and/or system level and initiate escalation procedures when necessary.

* Work collaboratively with the business areas to identify areas of improvement and opportunities for efficiencies.

* Audit operational transactions, including Enrollment, Billing, Claims, Appeals and Client Setup, ensuring adherence to departmental policies and procedures.

* Review end-to-end operational activities to verify compliance with internal standards and regulatory requirements.

* Provide timely, documented feedback on issues identified at the processor and/or system level, and initiate escalation procedures when necessary.

* Identify process improvements and develop workflow and/or system recommendations for operational efficiencies.

* Perform analysis to identify trends and detect root causes of deficiencies, supporting continuous improvement initiatives.

* Design and execute test plans for new or modified processes, ensuring changes function as intended and comply with policies and regulations. Maintain detailed testing notes and documentation.

* Communicate effectively, both in writing and verbally, with internal and external teams.

* Support assigned projects, maintain documentation at the task level, monitor deadlines, and serve as a technical liaison when appropriate.

* Attend internal and external training to maintain proficiency on all systems and processes.

* Perform other duties as assigned.

* Minimum 3 to 5 years of quality review, auditing, or claims processing experience.

* Bachelor's Degree preferred.

* Demonstrated self-starter with strong problem-solving, attention to detail, analytical, organizational, and writing skills.

* Knowledge of systems, process flows and timelines to ensure requirement testing and implementation are compliant across operational disciplines.

* Ability to compile detailed system requirements, reporting and data mining to support business needs.

* Skilled in trend analysis and highly effective in communicating as the liaison with business partners on findings and recommendations focused on minimizing impacts to other areas and the customer.

* Superior written and verbal communication skills are required to provide business partners with information and tools to support system modifications and/or new implementations.

* Maintain flexibility in a team environment and identify process improvement opportunities and define system impacts that may result.

* Working knowledge and experience with healthcare plans, claims processing, client setup, enrollment, and other operational areas.

* Foundational knowledge of systems including, Front Office System (FOS), Health Rules Payor (HRP), H3O, ORMB, Service Now (SNOW).

* Ability to effectively work autonomously in a hybrid environment. Must be in the office 3 times per week (Tuesdays, Wednesdays, Thursdays).

IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability.

Must have an Android or iOS device which is compatible with the free Microsoft Authenticator app.